Managing Labor Pain

Childbirth pain certainly comes with a gain (you gain a baby, after all). Happily, there are a variety of medicated and unmedicated ways to help you cope with the pain labor brings your way …which means you can get that gain with less pain.

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They call it “labor” for a reason: It’s hard, painful work. Possibly the hardest, most painful work you’ll ever do — and probably, the longest day (or night…or both) you’ll ever put in. Fortunately, all that hard work and pain (yours!) comes with the biggest paycheck of your life: a cuddly bundle of baby joy (yours!). And the good news keeps coming: The truth is, childbirth doesn’t have to be a pain. There are plenty of ways to relieve childbirth pain, from medicated options to unmedicated options (or a combination of both). And most of them are yours for the choosing.

Managing Labor Pain the Nonmedicated Way

Whether you’re still on the medication fence or you’ve already staked your side, there’s definite benefits to exporing these techniques. Maybe you’ll tap into one — or more — while you’re going unmedicated, maybe you’ll tap into one right alongside the epidural. Choose from the following, but try to choose — and in many cases, practice — ahead. Some aren’t exactly do-it-yourself, so you’ll also have to arrange for the necessary licensed, certified complementary-medicine practitioner:

Distraction. Childbirth-education programs (the big names are Lamaze and Bradley, but there are plenty of others to choose from) generally rely on distraction, visualization, deep concentration, rhythmic breathing, or deep breathing to help you cope with labor pain. Childbirth-education classes are often available at hospital or birthing centers, community centers, or under the auspices of practitioners. Didn’t prepare? You can also visualize a favorite scene, or focus on a single point in the birthing room.

Acupuncture. Acupuncture triggers the release of several brain chemicals, including endorphins, which block pain signals. An acupuncturist (you’ll have to arrange for one ahead of time) inserts dozens of thin needles at prescribed points along invisible paths (or meridians) on the body that lead to the release of endorphins — and pain relief.

Acupressure. Acupressure (or shiatsu) works on the same principle as acupuncture, except that instead of getting poked with needles, your practitioner will use thumb or finger pressure (or will apply pressure with small beads) to stimulate the points.

Reflexology. With reflexology, pressure is applied only to the feet and sometimes the hands (and ears). Certified reflexologists believe that the internal organs — including the uterus — can be accessed through points on the feet, and, with the right manipulation, can result in labor-pain relief.

Transcutaneous electrical nerve stimulation (TENS). In TENS, available in some hospitals and birthing centers, electrodes are placed on the skin and deliver low-volt electrical pulses. The pulses are believed to stimulate nerve pathways (in this case to the uterus and cervix), blocking pain.

Massage. Massage or counterpressure can bring relaxing relief and can help diminish labor pain. Professional (the kind you might be lucky enough to get from an experienced doula) can be amazing, but your partner can easily give a hand, too.

Hydrotherapy. Laboring in water seems to reduce pain — or at the very least, it relaxes women during labor. Some hospitals and most birthing centers provide tubs for use during labor (and sometimes delivery).

Hypnobirthing. Hypnobirthing won’t numb your nerves, but it can get you (if you’re the suggestible type) so deeply relaxed that you are totally unaware of any discomfort. One caveat: This technique isn’t something you can pull out when that first contraction hits. You’ll have to practice quite a bit to be able to achieve total relaxation — and pain relief — even with a certified therapist at your side.

Managing Labor Pain the Medicated Way

Positive there’s a medication with your name on it just waiting for you in the birthing room? Certain your birth will be drug-free — no ifs, ands, or maybes? Either way, it’s a good idea to read up on all the options so you’ll be prepared for anything labor brings your way (sometimes it turns out to be easier than you’d think, sometimes it turns out to be tougher than you could ever imagine, sometimes a C-section takes the choice out of your hands entirely).

Epidural. The epidural, which is a regional anesthetic, is the pain relief of choice for two thirds of all women who deliver at hospitals in the United States. It can be used to relieve the pain of contractions (and there’s no need to wait until you’re dilated to a certain number of centimeters — they’ll bring it on whenever you’re ready) or to numb you for a C-section (that’s a pain you definitely don’t want to feel). An anesthesiologist administers the epidural anesthesia through a thin catheter that is inserted into your back (technically, into the epidural space, which is located between the ligament that sheathes the vertebrae and the membrane that covers the spinal cord) via a large needle, after your back’s been numbed. Fifteen minutes or so later, the drugs kick in — your entire lower body feels numb, which means you won’t feel the pain of contractions. Two reasons why the epidural is such a popular choice during childbirth: The anesthesia offers continuous, long-term pain relief (which you can adjust at various intervals), and it bypasses the bloodstream — making it safer for your baby. One downside: Some women have trouble pushing with an epidural, since they don’t have lower-body sensation.

Spinal block or saddle block. The spinal block is a regional anesthetic (which, like the epidural, also bypasses the bloodstream) given as a shot into the fluid around the spinal cord in the lower back. It can be used during active labor if childbirth is expected within two hours (for example, if you didn’t get an epidural during labor) or it can be used shortly before a C-section. It takes effect quickly and provides pain relief from the chest down for up to two hours. A saddle block is another fast-acting regional anesthetic that may be given to relieve the pain of forceps-assisted delivery, vacuum-assisted vaginal extractions, or episiotomies. It’s also given as a shot into the fluid around the spinal cord.

Combined spinal epidural. Also known as the walking epidural, this combo technique delivers the same amount of pain relief as a traditional epidural but with a smaller dose of medication. The anesthesiologist will give you an injection of anesthesia directly into the spinal fluid at the same time he or she inserts the epidural catheter into your back. The shot will take the edge off the pain, but you’ll still feel the muscles in your legs so you can move or walk around during labor (not that you’ll necessarily want to). If you decide you want more pain relief later, the anesthesiologist can pump more anesthesia through the epidural catheter. This option is available only in some hospitals.

Pudendal block. This type of labor-pain anesthesia is injected into the perineal or vaginal area to reduce localized pain, often before forceps or vacuum extraction or an episiotomy (you’ll still feel the full force of contractions during childbirth).

Narcotics. Injected into a muscle or through an IV, narcotics such as Demerol and Stadol are given to dull labor pain and enable a mom-to-be to rest for two to four hours so that she can better cope with contractions. Narcotics, which do enter the bloodstream, should not be given too close to delivery because they can affect a newborn’s reflexes and breathing.

Tranquilizers. Rarely, anti-anxiety tranquilizers are given to help anxious moms-to-be relax during childbirth. They are injected into a muscle or through an IV and start working quickly. Tranquilizers don’t relieve the pain of contractions, and some women don’t like the dopey, drowsy feeling they get from them. Also, because tranquilizers enter the bloodstream, the baby will feel some effects of the medication, too, so they shouldn’t be administered too close to delivery.

General anesthesia. General anesthesia — when you’re put to sleep entirely — is rarely used these days to relieve labor pain, except in specific cases for emergency surgical deliveries (when there’s no time for an epidural).

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